Originally published as JCO Early Release 10.1200/JCO.2007.15.8865 on December 8 2008

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Analysis of Risk Factors for Outcomes After Unrelated Cord Blood Transplantation in Adults With Lymphoid Malignancies: A Study by the Eurocord-Netcord and Lymphoma Working Party of the European Group for Blood and Marrow Transplantation

Celso A. Rodrigues, Guillermo Sanz, Claudio G. Brunstein, Jaime Sanz, John E. Wagner, Marc Renaud, Marcos de Lima, Mitchell S. Cairo, Sabine Fürst, Bernard Rio, Christopher Dalley, Enric Carreras, Jean-Luc Harousseau, Mohamad Mohty, Denis Taveira, Peter Dreger, Anna Sureda, Eliane Gluckman, Vanderson Rocha

From the Eurocord Office, Hôpital Saint Louis; Hôtel Dieu, Nantes; Hôtel Dieu, Paris; Hôpital La Miletrie, Poitiers; Institut Paoli Calmettes, Marseille, France; Hospital Universitário La Fe, Valencia; BMT Unit, Hospital Clínic Barcelona, IDIBAPS; Hospital Santa Creu i Sant Pau, Barcelona, Spain; University of Minnesota Medical School, Minneapolis, MN; The University of Texas M. D. Anderson Cancer Center, Houston, TX; Morgan Stanley Children's Hospital, New York Presbyterian, Columbia University, New York, NY; Royal Hallamshire Hospital, Sheffield, United Kingdom; and the University of Heidelberg, Heidelberg, Germany

Corresponding author: Celso A. Rodrigues, MD, Eurocord / ARTM-Hôpital Saint Louis, 1, Av Claude Vellefaux, 75475 Paris Cedex 10 France; e-mail: celsoarrais{at}uol.com.br

Purpose To determine risk factors of umbilical cord blood transplantation (UCBT) for patients with lymphoid malignancies.

Patients and Methods We evaluated 104 adult patients (median age, 41 years) who underwent unrelated donor UCBT for lymphoid malignancies. UCB grafts were two-antigen human leukocyte antigen–mismatched in 68%, and were composed of one (n = 78) or two (n = 26) units. Diagnoses were non-Hodgkin's lymphoma (NHL, n = 61), Hodgkin's lymphoma (HL, n = 29), and chronic lymphocytic leukemia (CLL, n = 14), with 87% having advanced disease and 60% having experienced failure with a prior autologous transplant. Sixty-four percent of patients received a reduced-intensity conditioning regimen and 46% low-dose total-body irradiation (TBI). Median follow-up was 18 months.

Results Cumulative incidence of neutrophil engraftment was 84% by day 60, with greater engraftment in recipients of higher CD34⁺ kg/cell dose (P = .0004). CI of non–relapse-related mortality (NRM) was 28% at 1 year, with a lower risk in patients treated with low-dose total-body irradiation (TBI; P = .03). Cumulative incidence of relapse or progression was 31% at 1 year, with a lower risk in recipients of double-unit UCBT (P = .03). The probability of progression-free survival (PFS) was 40% at 1 year, with improved survival in those with chemosensitive disease (49% v 34%; P = .03), who received conditioning regimens containing low-dose TBI (60% v 23%; P = .001), and higher nucleated cell dose (49% v 21%; P = .009).

Conclusion UCBT is a viable treatment for adults with advanced lymphoid malignancies. Chemosensitive disease, use of low-dose TBI, and higher cell dose were factors associated with significantly better outcome.

published online ahead of print at www.jco.org on December 8, 2008.

Supported by Grant No. 357706/6 from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Ministério da Educação (CAPES/MEC), Brazil (C.A.R.).

Presented in part at the 49th Annual Meeting of the American Society of Hematology, December 8-11, 2007, Atlanta, GA, and at the 34th Annual European Group of Blood and Marrow Transplantation Meeting, March 30-April 2, 2008, Florence, Italy.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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